For PCI, Way to Heart Is Through the Wrist

Action Points

More and more U.S. physicians are using the radial artery in the wrist for percutaneous coronary intervention (PCI) instead of the traditional femoral artery.

Point out that compared with traditional femoral access, transradial PCI is associated with fewer vascular and bleeding complications.

More and more U.S. physicians are using the radial artery in the wrist for percutaneous coronary intervention (PCI) instead of the traditional femoral artery, researchers reported.

In 2012, transradial PCI accounted for one in six such procedures in the U.S., up from less than one in 50 in 2007, according to Dmitriy Feldman, MD, of Weill Cornell Medical College in New York City, and colleagues.

In a retrospective analysis of nearly 3 million procedures, transradial PCI had better success rates and fewer complications than the transfemoral procedures, Feldman and colleagues reported in the June 11 issue of Circulation.

Despite the lower complication rate, Feldman and colleagues found, the rate of transradial PCI increased more slowly in some high-risk groups -- older patients, women, and those with acute coronary syndrome -- than it did over all.

Traditionally, femoral access has been taught and used in the U.S. for PCI, whereas the radial approach is frequently used in Europe, Feldman said.

But, he told MedPage Today, that is changing as more physicians in the U.S. turn to wrist access for PCI. "I do think that the gradual increase will continue," he said.

One roadblock is that the "tricks and techniques" needed to use the radial procedure effectively take some time to learn, he noted, but institutions and academic societies have set up training programs that are gathering steam.

Randomized trials and meta-analyses have found that the transradial route is associated with fewer complications, leading Feldman and colleagues to hypothesize the procedure might be growing in popularity.

To find out, they analyzed data on more than 2.8 million procedures, from 1,381 hospitals, collected by the National Cardiovascular Data Registry's CathPCI registry from January 2007 through September 2012.

The main outcome measures were trends over time and procedural outcomes, Feldman and colleagues reported.

Overall, transradial PCI accounted for 178,643 procedures from 2007 to 2012, or 6.3% of the total.

But in the first quarter of 2007, transradial procedures accounted for just 1.2% of the total, while in the third quarter of 2012, the proportion had risen to 16.1%, the researchers found.

High-risk patients -- those over 75, women, and people with acute coronary syndromes -- are more likely to have such complications and therefore would benefit more from transradial PCI, the researchers noted; but they were less likely to be offered the procedure.

For instance, the rate of transradial PCI in patients under age 75 accounted for 17% of all procedures in the third quarter of 2012, compared with 13% for older patients.

The overall improved safety of the radial procedure, Feldman told MedPage Today, might arise from the ease with which doctors can stop bleeding at the access point when the radial artery is used.

The researchers cautioned that the study was retrospective, so unmeasured confounding factors might have affected the analysis. And the data only included successful attempts to gain access, so it was not possible to know how often crossover from one type to the other occurred.

The study was supported by the American College of Cardiology Foundation. Feldman reported financial links with Maquet Cardiovascular, Gilead Sciences, Eli Lilly, Daiichi-Sankyo, Abbott Vascular, and The Medicines Company.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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